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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP, AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES, CMI.ENGINEERS FOR INCLUSION IN SURFACE/SUB SURFACE <br /> CONTAMINATION REPORT.^^� �� e (V^ d44-` t%-`v-y`� <br /> L Date you acquired property I O�d APN: J t SJ Co. �r C <br /> 2. Use of property since acquisition�rC ' e"n <br /> 3. How many irrigation wells serve the property: Depth of well(s)if <br /> known <br /> 4. Do you have a permit to apply chemicals or fertilizers to the parcel?If yes,for what years <br /> Describe the products produced <br /> 5. Do you have any knowledge of any of the follovjaSJbjQng present on the parcel under study? <br /> A. Any disposal site,by former/present own f fuels hazardous materials,chemicals or any other <br /> substance consid a cor�substance by State/Fede Law. Y No es, <br /> pie xplain. \\ c <br /> B. Existing cistern,hand dug well or leac field,no ton ger in use. Yes No _(If yes <br /> please locate on property for the field review which is to be completed after receipt of this form.) <br /> C. Structures that are considered unsafe by you or local authorities. Yes No_ <br /> D. Flooding of parcel in part,or whole. Yes No '><_Ifyes,what years <br /> E.Contamination of air or soil from adjacent parcels Yes No X <br /> F. Failed septic system,that required repair or additional work Yes No -><If yes describe work <br /> done <br /> G_ A prior/present condition that may preclude developement of thearcel(s). Yes No <br /> H. A specific location where e*pment was/is fueled. Yes No <br /> 6.Name of former owner Do you know what use was <br /> made of the land by the owner?If so, please describe <br /> 7. Has the land been deep ripped since owned by you?Yes No;X—_ <br /> 8. Are you aware of any perched water table/springs or on occasion pools of water on site?Yes—No X <br /> Comments: <br /> ( er/Rep. Signature Date <br />